Safe Hands - Newcastle, NSW
Person-Centred Service Planning Policy
This policy describes how Safe Hands plans, documents, delivers, and reviews supports in a way that puts each participant’s goals, strengths, and preferences at the centre of every decision - consistent with the NDIS Practice Standards and the NDIS Act 2013.
1. Purpose
Safe Hands believes that disability support is most effective - and most respectful - when it is genuinely built around the individual. Person-centred planning is not just a process; it is a way of thinking about how we relate to the people we support.
This policy ensures that all supports planned and delivered by Safe Hands:
- Are designed and led by the participant, with workers in a supporting role
- Reflect the participant’s own goals, values, culture, and preferences
- Build on participant strengths rather than focusing only on deficits
- Maximise participant independence and community inclusion
- Meet our obligations under the NDIS Practice Standards, Core Module - Quality Indicator 1.1
2. Core Principles
Choice & Control
Participants choose what supports they receive, who provides them, when, where, and how. Workers facilitate - they do not direct.
Strengths-Based
Planning begins with what the participant can do and what they want to achieve - not what they cannot do.
Holistic & Whole-of-Life
We look at the participant’s whole life - relationships, community, culture, wellbeing - not just their support needs.
Collaborative
Planning is done with the participant, not for them. Family and carers are involved only with the participant’s consent.
Responsive
Plans are living documents that change as the participant’s goals and circumstances change - not set-and-forget paperwork.
Culturally Safe
We respect and actively incorporate each participant’s cultural identity, practices, family structures, and communication preferences.
3. Individual Support Plan Development
Every participant receives an Individual Support Plan (ISP) that is developed collaboratively before services begin and reviewed at least annually. The ISP must include:
3.1 Essential Plan Components
- Participant profile: Preferred name, communication needs, cultural background, important people in their life
- Goals and aspirations: Short-term and long-term goals in the participant’s own words where possible
- Strengths and abilities: What the participant does well, what they enjoy, what they want to build on
- Support needs: Specific daily living, personal care, community, or therapeutic supports required
- Preferences for support delivery: How, when, where, and by whom (including any worker gender preferences)
- Risk identification and management: Any known risks and agreed strategies to manage them safely
- Emergency and crisis plan: Key contacts, known triggers, and what to do if the participant is in distress
- Consent and communication: Who the participant has authorised to speak on their behalf
- NDIS plan funding details: Relevant support categories and budget information
1
Conversation & Listening
A support coordinator or senior worker meets with the participant to genuinely listen to what matters to them. This is not a form-filling exercise - it is a real conversation about the participant’s life and what they want from it.
2
Draft Plan Development
A draft ISP is prepared based on the conversation. It is written in plain language. The participant is offered a copy to review before signing.
3
Review & Sign-Off
The participant (and any authorised representative) reviews the draft and approves it. Changes are made until the participant is satisfied. The plan is then signed by both the participant and a Safe Hands representative.
4
Sharing with Support Team
Relevant sections of the ISP are shared with workers who will be delivering supports. Workers read and sign to confirm they have understood the participant’s plan before their first shift.
4. Supported Decision-Making
Safe Hands recognises that all people have the right to make decisions about their own lives. Where a participant has difficulty making or communicating decisions, we do not take over - we provide the support they need to make their own decisions.
- Provide information in plain language, Easy English, pictures, or other accessible formats
- Allow adequate time for the participant to think, ask questions, and decide
- Support the use of communication aids, interpreters, or decision-making tools
- Involve a trusted support person (family member, carer, or advocate) with the participant’s permission
- Never assume a person cannot make a decision - presume capacity first
Where a formal substitute decision-maker (guardian or financial administrator) has been appointed, Safe Hands will work with that person while still keeping the participant at the centre of all discussions.
5. Progress Monitoring & Documentation
Workers delivering supports are responsible for documenting each session accurately and in a timely manner. Progress notes must:
- Record the supports provided, duration, and any significant events
- Note progress toward goals and any changes in the participant’s needs or preferences
- Be written factually - describe what was observed, not opinions or assumptions
- Be completed on the day of the support (or within 24 hours in exceptional circumstances)
- Be stored securely in accordance with our Privacy Policy (POL-PRV-001)
Progress notes are used in plan reviews and may be shared with other providers with participant consent.
6. Plan Reviews
Individual Support Plans are formally reviewed at the following intervals:
| Trigger | Review Type | Timeframe |
|---|---|---|
| Routine review | Full ISP review with participant | At least annually or at NDIS plan review |
| Significant change in participant circumstances | Prompted review | Within 10 business days of change being identified |
| Participant request | Review meeting at participant’s request | Within 10 business days of request |
| Incident or serious concern | Safety-focused review | Immediately or as soon as safe to do so |
Reviews are conducted with the participant present. Workers are consulted on progress and any operational issues. Updated plans are signed by the participant and filed securely.
7. Family and Carer Involvement
Family members and carers play an important role in many participants’ lives. Safe Hands welcomes their involvement in planning - but always with the participant’s explicit consent. Workers must:
- Never share plan information with family members or carers without the participant’s consent
- Support the participant to have family involved at the level they choose - including not at all
- Recognise that family perspectives, while valuable, do not override the participant’s own wishes
- Acknowledge that some participants may have complex or difficult family relationships that affect how family involvement should be managed
8. Related Documents
- Human Rights & Participant Rights Policy (POL-RTS-001)
- Service Access & Exit Policy (POL-SAE-001)
- Privacy Policy (POL-PRV-001)
- Incident Management Policy (POL-INC-001)
- Positive Behaviour Support & Restrictive Practices Policy (POL-PBS-001)
- Individual Support Plan template (FORM-ISP-001)
This policy has been reviewed and approved by the Director / CEO of Safe Hands and is effective from 1 January 2026.
Approved by
Rujal S - Director / CEO, Safe Hands
Date Approved
1 January 2026
Effective date
Document ID: POL-PCP-001 | © 2026 Safe Hands Disability | ABN 31 315 518 918